Funding concerns lead to new focus on public health finance.

TO STRENGTHEN the nation's public health system and ensure its sustainability, a new movement is under way to advance the field of public health finance as a subfield within public health. Fueling the effort is a growing sense of urgency to increase the public health work force's understanding of funding and its impact on the public health system.

Within the public health work force, knowledge of the sources and uses of public health funding is minimal, the movement's organizers say, but dwindling resources, competing priorities for funding and an increased focus on accountability have created an immediate need to implement financial management practices in public health.

For the nation's public health work force, the issue carries bottom-line consequences, because fewer resources will translate into lower budgets, a weakened public health system relative to other areas of health care, an inability to attract new talent and lower salaries overall.

"In an environment of limited resources, it is difficult for public health to prove its worth to the people who are distributing the resources," said APHA member Walter J. Jones, PhD, MHSA, MA, a professor in the Department of Health Administration and Policy at the Medical University of South Carolina in Charleston. "Given the cost of health care and given the increased pressure on resources, people who want resources increasingly need to be able to document that the resources were used to achieve measurable, positive outcomes, and public health is often behind the rest of health care in developing the techniques to do that."

While most health workers are familiar with public health funding, public health finance is a broader issue. Finance looks at how funding is acquired, used and managed and links the impact of funding to population health and the public health system.

Presently, schools of public health do not offer extensive or systematic curricula in financial research methods, according to public health finance leaders.

"We certainly teach financial management in schools of public health, but those courses haven't focused on financial management issues within public health organizations," said APHA member Glen P. Mays, PhD, MPH, chair of the Department of Health Policy and Management at the University of Arkansas for Medical Sciences' Fay W. Boozman College of Public Health.

Financial management courses taught in schools of public health typically focus on applying the concepts to health care setting, not to public health setting, Mays said, "so we need to begin to incorporate more of a public health orientation to those financial management courses."

The ability to measure and analyze the financial performance of an organization is critical to ensuring the sustainability of an organization, noted APHA member Peggy Honore, DHA, MHA, assistant professor at the University of Southern Mississippi College of Health.

"If we don't teach these skills in schools of public health or in leadership institutes, then the work force will not be prepared to do this sort of analysis, and this analysis is very important for assessing the financial status and sustainability of public health organizations," said Honore, who is leading the effort to advance a field of study in public health finance and public health systems research, which examines the organization, financing and delivery of public health services. "I would like to see the field of public health finance advance to where these practices would become mainstream throughout the public health profession."

With a three-year, $675,000 grant from the Robert Wood Johnson Foundation, the effort to advance the field of public health finance as a subfield within public health is breaking new ground. On Feb. 13, representatives from the Journal of Public Health Management and Practice held an event at the National Press Club in Washington, D.C., to celebrate the release of the March/April 2007 issue, which was dedicated exclusively to public health finance topics.

The following day, a diverse group of public health leaders gathered in Washington, D.C., to convene the National Public Health Finance Meeting. Participants at the first-of-its-kind event discussed the challenges and possible responses to the issues surrounding public health finance, shared findings from the public health finance issue of the Journal of Public Health Management and Practice and developed a consensus supporting a set of strategic action recommendations for the continuing development of public health finance as a subfield within public health.

According to the recommendations, if public health finance is to become a vital part of public health, it must, along with public health as a whole, revitalize itself through strategic engagements with other health care and community groups. Meeting participants noted that many policy-makers do not have a clear idea of what public health does. Therefore, the recommendations noted, "it is hard to successfully argue for more public health funding, or for the funders to clearly see what they have purchased for their money in terms of community health impacts."

"If you don't have the data and don't have the analytical methods to interpret and employ the data, you can't make the case of public health effectiveness as well as some other areas of health care," Jones said.

One recommendation made during the National Public Health Finance Meeting is under way now as public health finance experts finalize plans for a first-ever public health finance Learning Institute. The institute will be held at APHA's 135th Annual Meeting in Washington, D.C., in November. The institute, "Measuring and Improving the Financial Performance of Local Public Health Agencies," session 1012, is set for Nov. 3. Participants can earn three continuing education credits.

"Hopefully, this learning institute will be a first step, but down the road this sort of thing shouldn't be a premeeting at a conference," Jones said. "It is something that should be done regularly in public health educational curricula."

For information about APHA's Learning Institutes, visit www.apha.org/programs/education/aphalearning+institute.